Personal view or opinion piece
Open Access

Medical Educators: How we learn, how we teach and the symbiotic relationship between the two pursuits

Lynne Reid[1]

Institution: 1. James Cook University
Corresponding Author: Dr Lynne Reid ([email protected])
Categories: Educational Strategies, Educational Theory, Teachers/Trainers (including Faculty Development), Teaching and Learning, Undergraduate/Graduate
Published Date: 23/07/2018

Abstract

As both a medical educator and a life long student, I can appreciate the complexity of adult learning.  In this reflective essay I explore the characteristics of my own learning styles and how this influences my teaching. 

Keywords: Medical education; learning styles; the teacher as a learner; adult learning

Introduction

As both an educator and a student, I can appreciate the complexity of adult learning.  In this reflective essay, I examine my own approach to learning and how that influences how I teach.

Recently I have been tasked with teaching fourth year medical students the principals of clinical investigations.  Whilst I have a practical working knowledge of the subject, much of the content is theory that I was taught twenty years ago and promptly forgot after my own undergraduate learning came to an end.  I was returning to a topic with some working knowledge but certainly no depth of knowledge.  I needed to relearn the material to a much higher level that would equip me to transfer my knowledge to a group of students and confidently answer questions. Reflecting on my own motivation to learn in this instance, it is certainly the case that enhancing the student learning experience was my main drive.

Discussion

There are many theories that endeavor to explain the manner in which students learn.   These theories also look at the issues which influence student learning.  Teaching and learning within the healthcare profession is an interesting domain to explore the range of educational theories, the concepts and strategies relevant to this type of adult learning.  Whilst I have focused mainly on delivering teaching in recent years, I now find myself exploring and reflecting on my own learning.

Any theoretical model that tries to describe adult learning through educational theory will have acknowledged both motivation and reflection (Taylor, 2013).  Here I look to examine the factors that influence student learning and reflect on my own experience.

Cognitive constructivism states that we construct our knowledge based on what we already know.  We then make decisions about when and how to develop our knowledge (Cantillon P, 2010). The process of learning this subject involved me firstly, questioning myself.  What do I already know?  What do I need to learn?   Vygotsky (1978, pp. 34-40) describes constructivism as benefiting learners through interactions with teachers and other learners.  This was most definitely the case in my own learning journey.  Without conscious planning, I entered a very efficacious learning environment.  The intensity of my learning was at its greatest when I was interacting with my first term tutorial group.  Whilst I had prepared myself by reading the coursework and revising my prior knowledge, I had not adequately tested my knowledge.  My understanding of the matter was advanced both during the tutorial and after the tutorial, by the students’ analysis of the subject and their questioning of me.  Only when I was tested by other learners about what they needed to know, could I identify areas of my own knowledge that were lacking.

According to Dewey (1933) reflective practice involves five phases:

  1. Suggestion
  2. Problem Setting
  3. Hypothesis or guiding idea
  4. Reasoning
  5. Testing

At the suggestion stage, the ideas and concepts that I was explaining to the students were being dissected by them, which in turn produced lines of questioning that I had not anticipated. As answers to the new queries were not readily available to me I was tasked with hypothesizing the answers and then finding the information with the resources that we had.   I did this with my class as an exercise.  The class split into smaller groups to explore the online resources, thus completing the problem setting phase.  By gathering more information and exploring possible solutions I passed through the guiding idea phase to reach a stage of reasoning and considering all the possibilities available to me.  By applying my newly extended knowledge of the subject, I was able to approach the subsequent lines of question with a new depth of knowledge.

By revisiting Vygotsky’s theory and recognizing that learning occurs in a zone of proximal development (ZPD) I can acknowledge that collaboration with the students advanced my learning, beyond that which I could have reached on my own (Cantillon P, 2010, pp. 1-3).

Reflecting on my own experience, I can acknowledge that my understanding of the subject matter increased greatly through the active participation in information gathering and analysis with other learners.  However, the actual skill that I chiefly developed was as a result of the experience that I had had.  The process of acknowledging the limitations of my understanding, confronting the weakened teacher – student relationship in the context of a tutorial, but developing a strategy to compensate was extremely useful.  To further extrapolate the value of this, it can be applied to experiential learning theory described by Kolb (1984, pp. 21-22).  Kolb explains that learning is a four-step process.  1) The learner has an experience; 2) the learner observes and reflects on the experience; 3) the learner forms abstract concepts about the experience and 4) the learner tests the concepts in new situations. 

Bloom’s taxonomy further demonstrates a stepwise progression from superficial learning to understanding that can be applied and evaluated.  This development in the 1950s, was an attempt to classify educational goals and objectives.  Ultimately the classification became a taxonomy of three domains which were the cognitive, affective and psychomotor.  The initial publication concerned itself primarily with the cognitive domain (Bloom, 1956, p. 7).  The cognitive domain is further split into six levels.  The first level is knowledge and would include reading and remembering text, recalling lecture content and rote learning based on repetition. The second level is comprehension and would involve being able to explain a theory, able to translate or summarise.  The next level is application.  An example of application would be applying knowledge to a new situation or problem. The fourth level is analyzing and can be characterized as an ability to deconstruct the learning. Synthesis is the subsequent level where elements of learning are pieced together to create a new finding. The final level is evaluation and requires the learner to be able to summarise and assess the process and outcomes (Bloom, 1956, pp. 201-206).

It is apparent that many theories exist which can aid the medical educator but perhaps a ‘Multi-theories’ model as proposed by Taylor & Hamdy which centers on a five stage process of dissonance (challenging the learner’s knowledge and finding it lacking), refinement (seeking explanations or solutions), organization (restructuring of ideas), feedback (where the newly acquired knowledge is tested by the teacher or peers), and finally consolidation (reflecting on learning experience and knowledge gained)(Taylor, 2013). In conclusion, student learning is influenced by multiple factors such as motivation, readiness and experience.  Reflection and evaluation allow the learner to consolidate their learning but also move from a stage-wise process with an end point, to a cycle of learning.  In a cycle of learning the acquired knowledge is applied, evaluated and tested, thus posing further questions to be answered.

Conclusion

In conclusion, as medical educators we can appreciate the benefit of learning with other learners and we can improve the learning experience for the students by testing our own knowledge before a teaching episode, during tutorials but also afterwards when reflecting on the delivery of the lesson.   As educators we must realise that reflection is an important part of the process and leads to greater understanding.

Take Home Messages

Teaching and learning are naturally intertwined and the opportunity to reflect on our own learning styles and how these can influence our teaching is a great opportunity to develop a deeper understanding of new subject matter.  We must take time out of our busy schedules to do this reflection which will add quality to our education programmes and the delivery of teaching.

Notes On Contributors

Dr Lynne Reid is a working General Practitioner who also works as a lecturer and academic co-ordinator for the undergraduate medicine at James Cook University.  She is also the Lead Medical Educator for postgraduate General Practice training with Generalist Medical Training at James Cook University.  Dr Reid is currently completing a Masters in Health Professional Education at James Cook University.

Acknowledgements

Bibliography/References

Bloom, B. S., Engelhart M.D., Furst, E.J, Hill, et al. (1956) Taxonomy of educational objectives: The classification of educational goals, Handbook I : Cognitive Domain. New York: Longmans Green.

Cantillon P, W. D. (2010) ABC pf Learning and Teaching in Medicine Second Edition. Wiley Blackwell.

Dewey, J. (1933) How We Think. A restatement of the relation of reflective thinking to the educative process. Boston: DC Heath.

Kolb, D. A. (1984) Experiential learning: experience as the. NJ: Prentice Hall.

Taylor, D. C. M. and Hamdy, H. (2013) 'Adult Learning Theories: Implications for learning and teaching in medical education: AMEE Guide No.83', Medical Teacher, p. e1562. https://doi.org/10.3109/0142159X.2013.828153

Vygotsky (1978) Interaction Between Learning and Development. New york: Govain & Cole.

Appendices

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethics approval was not necessary as this is a reflective essay only.

External Funding

This paper has not had any External Funding

Reviews

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Subha Ramani - (25/07/2018) Panel Member Icon
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It was interesting to read this educator's reflections on how she learned and how this influenced her teaching. I also enjoyed reading the various theories that the author considered important factors in influencing teaching and learning. Some are educational theories, some psychological theories applicable in education, but I felt there was an abrupt transition to Bloom's taxonomy. Bloom's levels are more applicable when writing learning objectives or developing test questions or asking questions to assess learners rather than a theory. it is indeed important for educators to write objectives and ask questions that target higher levels.
What I am not seeing in this article, albeit a short reflection piece, is how these theories intersect in the author's own professional life and influence her teaching and what experiences led to these discoveries.
I wonder also whether the depth of learning in a community is being underestimated when the author describes how her experiences were the greatest contributor to her skills. Perhaps, being in a community of learners or teachers allows one to learn more from their experiences?
Interesting starter article, hopefully we can look forward to details experiences, how they relate to learning theories and how they change one's teaching philosophy and practice.
Carla Lupi - (24/07/2018)
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This reflective essay offers brief descriptions of different theories of learning (constructivism, reflective practice, zone of proximal development, the Kolb cycle, “multi-theories”), as well as a review of Bloom’s taxonomy. The author maps a description of a class session, likely the one referenced in the introduction, to 5 phases of reflective practice. The author offers that elements of learning theories were applicable to her other experiences but does not provide any detail on the content of those experiences. Therefore, the analysis of those experiences is also missing. For example, the mention of the zone of proximal development and collaboration with students would be much more engaging with a short description of that collaboration and of the author’s subsequent learning. Her mention of the “weakened teacher-student relationship” and a “strategy to compensate”, again without detail, left this reader curious about the gist of what could ultimately be a powerful reflection-in-action.

Strong reflections on teaching and learning, through the lens of learning theories or other schema, always have value. I hope this writer might return with more detailed descriptions of the contexts of her reflection, and the thoughts and feelings that resulted in her learning that in turn illustrated the different elements of the learning theories she references